Our latest Current Concepts, Early-Stage Hodgkin’s Lymphoma, comes from Dr. James O. Armitage of the University of Nebraska Medical Center.
The treatment of patients with early-stage Hodgkin’s lymphoma is one of the success stories of modern oncology. Today, more than 90% of such patients will survive for at least 5 years after diagnosis.
• What is the incidence of second malignancies in patients treated with radiotherapy?
Second malignant conditions occur at an average rate of approximately 1% per year for at least 30 years after treatment. The risk is particularly high for women younger than 30 years of age who receive thoracic radiotherapy; breast cancer develops in 30 to 40% of these patients in the 25 years after treatment.
• What are the cardiovascular complications of radiotherapy when used to treat patients with Hodgkin’s disease?
Radiation-related cardiac disease can be manifested as coronary artery disease, myocardial injury, valvular disease, or pericardial fibrosis. The risk of death from myocardial infarction is increased after thoracic radiotherapy, and that increased risk persists for more than 25 years. Diastolic dysfunction after radiotherapy seems to be a marker for an increased risk of cardiac events. The incidence of stroke also rises in patients who receive radiotherapy in the neck and mediastinum.
Morning Report Questions
Q: How should pregnant patients with Hodgkin’s disease be managed?
A: In pregnant patients with asymptomatic, early-stage Hodgkin’s lymphoma, treatment can sometimes be delayed until delivery. Although radiotherapy should be avoided during pregnancy, it is relatively safe to treat patients in the second and third trimesters with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).
Q: How should patients with HIV infection in whom Hodgkin’s lymphoma develops be treated?
A: Hodgkin’s lymphoma is one of the defining illnesses of the acquired immunodeficiency syndrome (AIDS). Patients with HIV infection in whom Hodgkin’s lymphoma develops typically have the mixed-cellularity or lymphocyte-depletion histologic subtype, and they tend to have widespread disease, involvement of extranodal sites, and systemic symptoms. The availability of highly active antiretroviral therapy has dramatically improved the survival rate among patients with HIV infection who also have Hodgkin’s lymphoma. Today, HIV-infected patients with early-stage Hodgkin’s lymphoma should receive the same treatment as patients with early-stage disease who are not infected with HIV.